Afro-Egypt J Infect Endem Dis 2011 Dec ;1(2):A7

 

Spontaneous Bacterial Peritonitis in Cirrhotic Patients

 

El Sehly A

 

Cairo University, Egypt

 

                              

 

ABSTRACT

Cirrhotic patients with poor liver functions are prone to bacterial infections as spontaneous bacterial peritonitis ( SBP) , urinary tract infections , bacteraemia and respiratory tract infections. SBP should be suspected in any deterioration of the cirrhotic patients . 10- 27 % of admitted ascetic patients have SBP. The recurrence rate and mortality of SBP are 70% and 31% respectively. One third of cases of hepato-renal syndrome have SBP. Clinically the patient of SBP has fever , abdominal pain , tender abdomen , encephalopathy and hypotension. The long term daily prophylaxis by oral norfloxacin carries the risk of resistance to quinolones and should be restricted to high risk patients. The diagnosis is established clinically, by findings of > 250 polymorphoneuclear leucocytes (PMN) / dl in ascetic fluid and ascetic fluid culture . Treatment should be started before the result of the culture. Secondary bacterial peritonitis should be suspected if there is a lack of response to antibiotics , 2 or more organisms detected in ascetic fluid culture , ascetic fluid glucose < 50 mg/dl , ascetic fluid protein > 10 gm / dl and ascetic fluid LDH .> serum LDH. Bacterascites means culture positive ascetic fluid with PMN < 250 /dl in the ascetic fluid. The treatment of SBP is by empiric cefotaxime 2 gm /12 hrs for 5 days . Ceftriaxon , amoxicillin- clavulinic acid and quinolones (if no prophylaxis with norfloxacin) could be used.